The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis

Kirolos, A., Blacow, R. M., Parajuli, A., Welton, N. J., Khanna, A., Allen, S. J., McAllister, D. A. , Campbell, H. and Nair, H. (2021) The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis. BMJ Global Health, 6(11), e007411. (doi: 10.1136/bmjgh-2021-007411) (PMID:34848440) (PMCID:PMC8634228)

Abstract

Introduction: Childhood malnutrition is widespread in low-income and middle-income countries (LMICs) and increases the frequency and severity of infections such as pneumonia. We aimed to identify studies investigating pneumonia deaths in malnourished children and estimate mortality risk by malnutrition severity. Methods: We conducted a systematic review of MEDLINE, EMBASE and Global Health databases to identify relevant studies. We used a network meta-analysis to derive ORs of death from pneumonia for moderately and severely underweight children using low weight-for-age, the most reported measure of malnutrition. We compared meta-estimates of studies conducted before and after 2000 to assess changes in mortality risk over time. We estimated the prevalence of underweight hospitalised children from hospital-based cohort studies and calculated the population attributable fraction of in-hospital pneumonia deaths from being underweight using our results. Results: Our network meta-analysis included 33 544 underweight children from 23 studies. The estimated OR of death from pneumonia was 2.0 (95% CI 1.6 to 2.6) and 4.6 (95% CI 3.7 to 5.9) for children moderately and severely underweight, respectively. The OR of death from pneumonia for those severely underweight was 5.3 (95% CI 3.9 to 7.4) pre-2000 and remained high post-2000 at 4.1 (95% CI 3.0 to 6.0). Prevalence of underweight children hospitalised with pneumonia varied (median 40.2%, range 19.6–66.3) but was high across many LMIC settings. We estimated a median 18.3% (range 10.8–34.6) and 40.9% (range 14.7–69.9) of in-hospital pneumonia deaths were attributable to being moderately and severely underweight, respectively. Conclusions: The risk of death from childhood pneumonia dramatically increases with malnutrition severity. This risk has remained high in recent years with an estimated over half of in-hospital pneumonia deaths attributable to child malnutrition. Prevention and treatment of all child malnutrition must be prioritised to maintain progress on reducing pneumonia deaths.

• Item Type: Articles
• Additional Information: AKi is supported by a Wellcome Trust Clinical PhD Programme Fellowship (203919/Z/16/Z). DAM is funded via a Wellcome Trust intermediate clinical fellowship and Beit fellowship (201492/Z/16/Z).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Blacow, Dr Rachel and McAllister, Professor David
• Authors: Kirolos, A., Blacow, R. M., Parajuli, A., Welton, N. J., Khanna, A., Allen, S. J., McAllister, D. A., Campbell, H., and Nair, H.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: BMJ Global Health
• Publisher: BMJ Publishing Group
• ISSN: 2059-7908
• ISSN (Online): 2059-7908
• Published Online: 30 November 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in BMJ Global Health 6(11): e007411
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
173492		Combining efficacy estimates from clinical trials with the natural history obtained from large routine healthcare databases to determine net overall treatment benefits	David McAllister	Wellcome Trust (WELLCOTR)	201492/Z/16/Z	Institute of Health & Wellbeing